To support the free and open dissemination of research findings and information on alcoholism and alcohol-related problems. To encourage open access to peer-reviewed articles free for all to view.

For full versions of posted research articles readers are encouraged to email requests for "electronic reprints" (text file, PDF files, FAX copies) to the corresponding or lead author, who is highlighted in the posting.


Saturday, December 22, 2007

The impact of smoking bans on alcohol demand
The Social Science Journal
Volume 44, Issue 4, 2007, Pages 664-676

Although many studies find that smoking bans reduce cigarette demand, arguments can be made for smoking bans also affecting alcohol demand.

Accordingly, in this paper we address the determinants of state-level alcohol demand, which we treat as a function of various economic and demographic variables, as well as smoking bans.

Results reveal that smoking bans reduce the demand for beer and spirits. Furthermore, smoking bans tend to intensify the complementary relationship between cigarettes and alcohol, which suggests that smoking bans have altered consumer demographics in the alcohol market.

We also find the nature of the smoking ban matters, as bans specific to restaurants and bars lead to larger reductions in beer and spirits consumption, but increase the demand for wine.

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The Application of Machine Learning Techniques as an Adjunct to Clinical Decision Making in Alcohol Dependence Treatment
Substance Use & Misuse, Volume 42, Issue 14 December 2007 , pages 2193 - 2206

With few exceptions, research in the addictive sciences has relied on linear statistics and methodologies. Addiction involves a complex array of nonlinear behaviors.

This study applies two machine learning techniques, Bayesian and decision tree classifiers, in the assessment of outcome of an alcohol dependence treatment program. These nonlinear approaches are compared to a standard linear analysis.

Seventy-three alcohol-dependent subjects undertaking a 12-week cognitive-behavioral therapy (CBT) program and 66 subjects undertaking an identical program but also prescribed the relapse prevention agent Acamprosate were employed in this study.

Demographic, alcohol use, dependence severity, craving, health-related quality of life, and psychological measures at baseline were used to predict abstinence at 12 weeks.

Decision trees had a 77% predictive accuracy across both data sets, Bayesian networks 73%, and discriminant analysis 42%.

Combined with clinical experience, machine learning approaches offer promise in understanding the complex relationships that underlie treatment outcome for abstinence-based alcohol treatment programs.

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Difficulties in emotion regulation and impulse control in recently abstinent alcoholics compared with social drinkers
Addictive Behaviors Volume 33, Issue 2, February 2008, Pages 388-394

Early abstinence from chronic alcohol dependence is associated with increased emotional sensitivity to stress-related craving as well as changes in brain systems associated with stress and emotional processing.

The aim of the current study was to examine potential difficulties in emotion regulation during early alcohol abstinence using the recently validated Difficulties of Emotion Regulation Scale (DERS).

Recently abstinent treatment-seeking alcohol abusers (n = 50) completed the DERS during their first week of inpatient treatment and at discharge (5 weeks later). These responses were compared to a group of social drinkers (n = 62).

Compared with social drinkers, alcohol-dependent patients reported significant differences in emotional awareness and impulse control during week 1 of treatment. Significant improvements in awareness and clarity of emotion were observed following 5 weeks of protracted abstinence. However, significant difficulties with impulse control persisted until discharge.

Findings from the DERS indicate protracted stress-related impulse control problems in abstinent alcoholics, which may contribute to increased relapse vulnerability

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Asking patients about their drinking A national survey among primary health care physicians and nurses in Sweden
Addictive Behaviors
Volume 33, Issue 2, February 2008, Pages 301-314

To investigate the extent to which Swedish primary health care (PHC) general practitioners (GPs) and nurses discuss alcohol issues with their patients, their reasons for and against addressing alcohol issues, their perceived importance of these issues, and factors that could facilitate increased alcohol intervention activity among the PHC professionals.

Fifty percent of the GPs and 28% of the nurses stated that they “frequently” discussed alcohol with their patients. The two most common reasons for asking patients about their drinking were that the GPs and nurses considered it part of their routines and the belief that the patient had alcohol-related symptoms.

GPs said that improved opportunities for referral to specialists and provision of more knowledge about counselling techniques for use when alcohol-related symptoms are evident were the most important facilitators to increased intervention activity.

Concerning the nurses, 93% stated that more time devoted to health-oriented work could facilitate increased alcohol intervention activity.

The findings highlight a considerable gap between the recognition of the significance of the alcohol problem and Swedish PHC intervention activity.

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Does gender moderate associations among impulsivity and health-risk behaviors�
Addictive Behaviors Volume 33, Issue 2, February 2008, Pages 252-265

The present study explores the relations among gender, impulsivity and three health-risk behaviors relevant to young adults (tobacco use, alcohol problems and gambling problems) in a sample of 197 college-age individuals. We sought to determine whether impulsivity is associated with health-risk behaviors in the same ways for men and women.

For tobacco use and gambling problems, men were at higher risk than women, and impulsivity was not significantly associated with higher risk.

Higher levels of motor impulsivity in men accounted for a significant amount of the gender difference in risk for alcohol problems. That is, impulsivity as measured by the Barratt Impulsiveness Scale (version 11), mediated the association between gender and risk for alcohol problems.

For impulsivity as measured by Stop Signal Reaction Time (i.e. response inhibition), gender moderated the association between impulsivity and alcohol problems. Specifically, lower levels of impulsivity were associated with greater risk for alcohol problems in both men and women, but the effect was stronger in men.

We speculate that this seemingly paradoxical result might be the result of coping drinking to deal with negative affect associated with behavioral overcontrol.

These findings suggest that prevention efforts might well focus on identifying individuals at high risk for alcohol problems, especially males, by assessing response inhibition.

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Beyond the “Binge” threshold: Heavy drinking patterns and their association with alcohol involvement indices in college students
Addictive Behaviors Volume 33, Issue 2, February 2008, Pages 225-234

Despite its ubiquity, the term “Binge” drinking has been controversial. Among other things, the grouping of drinkers into a single risk category based on a relatively low threshold may not capture adequately the nature of problem drinking behaviors.

The present study is an initial examination of the utility of delineating heavy drinkers into three groups; those who typically drink below the traditional “Binge” cutoff (less than 4+/5+ drinks per occasion for women/men), those who met traditional “Binge” drinking criteria, and a higher “Binge” cutoff of 6+/7+ (women, men). We examined differences in drunkenness, drinking frequency, and unique types of alcohol problems.

We found that the standard 4+/5+ drink “Binge” cutoff distinguishes drinkers across some but not all indices of alcohol involvement. “Binge” drinkers differed from their “Non-Binge” counterparts on eBAL, but for other indicators (drinking frequency, total alcohol consequences), only “Heavy Binge” drinkers differed significantly from “Non-Binge” drinkers.

Importantly, “Heavy Binge” drinkers experienced higher levels of those specific consequences associated with more problematic alcohol involvement.

Findings suggest that not all “Binge” drinkers drink alike, are equally drunk, or experience similar consequences. As such, there may be utility in distinguishing among heavy drinkers, in order to focus appropriately on those at greatest risk for different types of consequences.

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Friday, December 21, 2007

Approach to the genetics of alcoholism: A review based on pathophysiology
Biochemical Pharmacology Volume 75, Issue 1, 1 January 2008, Pages 160-177

Alcohol dependence is a common disorder with a heterogenous etiology. The results of family, twin and adoption studies on alcoholism are reviewed.

These studies have revealed a heritability of alcoholism of over 50%. After evaluating the results, it was epidemiologically stated that alcoholism is heterogenous complex disorder with a multiple genetic background.

Modern molecular genetic techniques allow examining specific genes involved in the pathophysiology of complex diseases such as alcoholism. Strategies for gene identification are introduced to the reader, including family-based and association studies.

The susceptibility genes that are in the focus of this article have been chosen because they are known to encode for underlying mechanisms that are linked to the pathophysiology of alcoholism or that are important for the pharmacotherapeutic approaches in the treatment of alcohol dependence. Postulated candidate genes of the metabolism of alcohol and of the involved neurotransmitter systems are introduced.

Genetic studies on alcoholism examining the metabolism of alcohol and the dopaminergic, GABAergic, glutamatergic, opioid, cholinergic and serotonergic neurotransmitter systems as well as the neuropeptide Y are presented.

The results are critically discussed followed by a discussion of possible consequences.

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Key Role of Ethanol-Derived Acetaldehyde in the Motivational Properties Induced by Intragastric Ethanol: A Conditioned Place Preference Study in the Rat
Alcoholism: Clinical and Experimental Research (OnlineEarly Articles) 21 December 2007

Acetaldehyde (ACD), the first metabolite of ethanol (EtOH), is produced peripherally by gastric and hepatic alcohol dehydrogenase (ADH) and centrally by brain catalase. In spite of the aversive properties classically ascribed to ACD, it has recently been suggested that ACD might mediate some of the motivational effects of EtOH. Accordingly, the relative role of ACD in the positive motivational properties of EtOH ingested is increasingly becoming the matter of debate.

Thus, we studied the ability of intragastrically administered EtOH, ACD and EtOH-derived ACD to induce conditioned place preference (cpp) in rats.

Both, EtOH and ACD dose-dependently induced cpp; further, while EtOH-induced cpp was prevented by the administration of 4-MP and by DP, ACD-induced cpp was unaltered by 4-MP administration and prevented by DP. Both pretreatments did not interfere with morphine-induced cpp indicating that 4-MP and DP specifically modulate the motivational properties of EtOH and ACD.

The ability of 4-MP and DP to decrease EtOH-induced cpp suggests that a reduction of ACD levels is crucial in depriving EtOH from its motivational properties as indexed by the cpp procedure. In addition, this conclusion is supported by the inefficacy of 4-MP in preventing ACD-induced cpp, and by its blockade observed after administration of the selective ACD sequestrating agent DP.

The present results underscore the role of EtOH-derived ACD in EtOH-induced motivational properties as well as its abuse liability.

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Acculturation, Drinking, and Alcohol Abuse and Dependence Among Hispanics in the Texas-Mexico Border
Alcoholism: Clinical and Experimental Research (OnlineEarly Articles) 21 December 2007

Acculturation has been linked to an increased prevalence of alcohol-related problems. However, most of the research has been conducted with Hispanic populations in metropolitan areas of the United States, none of which is on the U.S.–Mexico border.

This study examines the association between acculturation, heavy episodic drinking, and DSM-IV alcohol abuse and dependence among Hispanics in the Texas–Mexico border.

The study used data from a survey conducted (2002 to 2003) along the Texas–Mexico border and included 472 male and 484 female Hispanic adults from El Paso, the Rio Grande Valley, and colonias. Based on the Acculturation Rating Scale for Mexican Americans-II scale, respondents were coded into 4 acculturation categories: "very Mexican oriented,""Mexican bicultural,""Anglo bicultural," or "very Anglo/Anglicized.".

Acculturation was related to lower rates of alcohol use disorders among men and a higher frequency of heavy episodic drinking among women. Multivariate analyses indicate that men who report heavy episodic drinking and those who are "very Mexican,""bicultural Mexican," or "bicultural Anglo" are more at higher risk for alcohol abuse and/or dependence compared with "very Anglo/Anglicized" men. For women, acculturation level did not predict alcohol disorders.

Statistical analyses included testing for bivariate associations and multivariate logistic regression predicting heavy episodic drinking alcohol abuse or dependence.

This study suggests that acculturation has different effects on drinking for men and women. This finding needs some attention as literature also indicates that women drink more and may develop more alcohol-related problems as they acculturate. This increase in women’s drinking is probably because of U.S. society’s more liberal norms governing female drinking. The "bimodal" distribution of risk, in which only men in "very Anglo" group are at a lower risk than the others, may be unique to the Border.

The association between acculturation and alcohol use disorders does not appear to be linear and the effect of acculturation is not uniform on individuals’ drinking behavior.

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A Comparison of Results From an Alcohol Survey of a Prerecruited Internet Panel and the National Epidemiologic Survey on Alcohol and Related Conditions
Alcoholism: Clinical and Experimental Research (OnlineEarly Articles) 21 December 2007

Given today’s telecommunications environment, random digit dial (RDD) telephone surveys face declining response rates and coverage, and increasing costs. As an alternative to RDD, we surveyed participants in a randomly recruited standing Internet panel supplemented with a randomly sampled telephone survey of nonpanel members for a study of associations between onset of alcohol use and later alcohol-related problems.

The purpose of this paper was to compare results from our survey with results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a face-to-face probability sample survey of 43,093 adults, with a focus on associations between demographics, age of drinking onset, and alcohol dependence.

Demographic and drinking characteristics from our survey of 4,021 ever-drinkers between the ages of 18 and 39 years were compared with the characteristics of 11,549 similarly aged ever-drinkers from the NESARC. Weighted analyses accounting for sampling design compared these 2 samples on drinking characteristics over the past year and during a respondent’s heaviest period of drinking, and in multivariate models examining associations between demographics, age of drinking onset, and lifetime alcohol dependence.

Participants in the supplemented Internet panel were similar to the national population of 18- to 39-year-old ever drinkers on gender, education, and race/ethnicity, while adults who were aged 18 to 25 years were under-represented in the Internet panel. The supplemented Internet panel reported higher rates of moderate risk drinking over the past 12 months, lifetime high-risk drinking, and lifetime (ever) alcohol dependence. Estimates of the associations between alcohol dependence and age of drinking onset, risky drinking, and family history of alcohol problems did not significantly differ between the supplemented Internet sample and the NESARC survey.

Randomly recruited Internet-based panels may provide an alternative to random digit dial telephone surveys and in-person surveys for some studies of factors associated with alcohol-related problems

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DSM-IV Criteria Endorsement Patterns in Alcohol Dependence: Relationship to Severity
Alcoholism: Clinical and Experimental Research (OnlineEarly Articles) 21 December 2007

In DSM-IV, the diagnostic threshold for alcohol dependence (AD) is met when a patient presents with at least 3 of 7 criteria. We have computed the predictive value for each individual DSM-IV AD criterion, and examined subtypes of AD criteria endorsement patterns and their associated severity indicators for community-dwelling AD individuals.

We utilized data from the 2001 to 2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Positive predictive values (PPV) for DSM-IV AD were computed for each of the individual criteria. Patterns of criteria endorsements were identified by latent class analysis (LCA). Sociodemographic status, age of onset and duration of AD, patterns of drinking, and drinking treatment history, were conditional on DSM criteria endorsement clusters, as indicators of the respondents’ clinical severity.

At the individual criterion level, the single criterion with the greatest PPV was D7—"Activities given up" with ~95% of drinking individuals who endorsed this DSM criterion correctly diagnosed as having DSM-IV AD. In addition to D7, only D5—"Physical/Psychological problems", and D6—"Time spent" had a PPV for AD substantially >50%. The LCA of AD endorsement patterns yielded a 6-cluster solution. The most common response pattern (34.5% of those with AD) was endorsement of 5 criteria: D1—"Quit/Control," D2—"Larger/Longer," D3—"Tolerance," D4—"Withdrawal," and D5—"Physical/Psychological problems." The most severe cluster (14%) was comprised of those who were likely to endorse 7/7 criteria. Cluster 1 (8.3%) did not include an endorsement of withdrawal, despite a heavy pattern of alcohol consumption. Unmarried status was associated with more severe criteria endorsement patterns.

The present findings indicate a Guttman-like scaling of endorsement which yielded associations with severity for some of the concurrent indicators included in the analysis. However, severity measures did not always increase with DSM-IV AD criterion endorsement counts. Although endorsement of 6/7 or 7/7 criteria was associated with greater severity across a variety of indicators, fewer criteria were randomly associated with these measures. These data do not support the use of AD symptom counts as a phenotypic dependent variable. At least 2 extant diagnostic criteria showed relatively low PPV for AD, indicating a need for further assessment of these criteria with new symptoms or re-wording of the current symptom items.

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Distinct Mechanisms of Ethanol Potentiation of Local and Paracapsular GABAergic Synapses in the Rat Basolateral Amygdala
JPET 324:251-260, 2008

Converging lines of behavioral and pharmacological evidence suggest that GABAergic synapses in the basolateral amygdala (BLA) may play an integral role in mediating the anxiolytic effects of ethanol (EtOH).

Since anxiety is thought to play an important role in the development of, and relapse to, alcoholism, elucidating the mechanisms through which EtOH modulates GABAergic synaptic transmission in the BLA may be fundamental in understanding the etiology of this disease.

A recent study in mice has shown that principal cells within the BLA receive inhibitory input from two distinct types of GABAergic interneurons: a loosely distributed population of local interneurons and a dense network of paracapsular (pcs) GABAergic cells clustered along the external capsule border.

Here, we sought to confirm the presence of these two populations of GABAergic synapses in the rat BLA and evaluate their ethanol sensitivity.

Our results suggest that rat BLA pyramidal cells receive distinct inhibitory input from local and pcs interneurons and that EtOH potentiates both populations of synapses, albeit via distinct mechanisms. EtOH enhancement of local inhibitory postsynaptic currents (IPSCs) was associated with a significant decrease in paired-pulse ratio (PPR) and was significantly potentiated by the GABAB receptor antagonist SCH 50911 [(+)-(S)-5,5-dimethylmorpholinyl-2-acetic acid], consistent with a facilitation of GABA release from presynaptic terminals. Conversely, EtOH enhancement of pcs IPSCs did not alter PPR and was not enhanced by SCH 50911 but was inhibited by blockade of noradrenergic receptors.

Collectively, these data reveal that EtOH can potentiate GABAergic inhibitory synaptic transmission in the rat BLA through at least two distinct pathways.

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Alcohol Use, Depressive Symptoms and the Receipt of Antiretroviral Therapy in Southwest Uganda
AIDS and Behavior Online First 30 October 2007

Alcohol use and depressive symptoms are associated with reduced access to antiretroviral therapy (ART) in the developed world. Whether alcohol use and depressive symptoms limit access to ART in resource-limited settings is unknown.

This cross-sectional study examined the association between alcohol use, depressive symptoms and the receipt of ART among randomly selected HIV-positive persons presenting for primary health care services at an outpatient HIV clinic in Uganda. Depressive symptoms were defined by the Hopkins Symptom Checklist and alcohol use was measured through frequency of consumption questions. Antiretroviral use was assessed using a standardized survey and confirmed by medical record review. Predictors of ART use were determined via logistic regression.

Among 421 HIV-infected patients, factors associated with the receipt of ART were having at least primary education, having an opportunistic infection in the last 3 months, and not drinking within the last year.

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Alcohol Use, Intimate Partner Violence, Sexual Coercion and HIV among Women Aged 15–24 in Rakai, Uganda
AIDS and Behavior Online First 7 Dec 2007

Disinhibition due to alcohol may induce intimate partner violence and sexual coercion and increased risk of HIV infection.

In a sample of 3,422 women aged 15–24 from the Rakai cohort, Uganda, we examined the association between self-reported alcohol use before sex, physical violence/sexual coercion in the past and prevalent HIV, using adjusted odds ratios (Adj OR) and 95% confidence intervals (95% CI).

During the previous year, physical violence (26.9%) and sexual coercion (13.4%) were common, and alcohol use before sex was associated with a higher risk of physical violence/sexual coercion.

HIV prevalence was significantly higher with alcohol consumption before sex (Adj OR = 1.45, 95% CI: 1.06–1.98) and especially when women reported both prior sexual coercion and alcohol use before sex (Adj OR = 1.79, 95% CI: 1.25–2.56).

Alcohol use before sex was associated with physical violence and sexual coercion, and both are jointly associated with HIV infection risk in young women.

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A Daily Process Investigation of Alcohol-involved Sexual Risk Behavior Among Economically Disadvantaged Problem Drinkers Living with HIV/AIDS
AIDS and Behavior Online First 11 Dec 2007

Alcohol use is believed to increase sexual risk behavior among people living with HIV/AIDS (PLWHA). As drinking and sexual risk acts often occur in the same social contexts, this association is difficult to confirm.

In this study, electronic daily diaries were completed by 116 PLWHA over 5 weeks. This yielded a total of 1,464 records consisting of data pertaining to discrete occasions of anal and vaginal sex. Simultaneous within- and between-person multilevel analyses were conducted, including situational variables (partner type, partner serostatus, partner drinking) and individual difference variables (gender, level of alcohol dependence).

The resulting model explains 27.5% of the variance and reveals that interactions among these situational and individual difference variables predict changes in the estimated rate of unprotected sex (US).

Also, in defined contexts, the amount of alcohol consumed prior to sex significantly affects the rate of US among members of the sample.

Implications are discussed.

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Mental Health & Substance Use: dual diagnosis
the conference

For the person experiencing co-existing mental health and substance use problems life presents many challenges. Their needs, often complex and multifaceted, extend beyond simply a mental health and substance use problem. For clinicians and services working with this group, this also presents many challenges. To effectively and creatively deliver care and services to meet the needs of individuals experiencing co-existing problems, professionals need to continually update knowledge and skills.

This one day conference explores some of the issues facing clients, professionals and services. It provides an insight into current thinking and latest developments in the field from a variety of perspectives: policy, practice and training. The conference draws together some of the UK’s leading clinicians, researchers and educators to consider how we meet the challenge, now and in the future, providing a thought provoking day.

In addition, the conference has the pleasure of hosting the UK launch of the new, international Taylor and Francis journal Mental Health and Substance Use: dual diagnosis and an opportunity to meet the Editor and members of the Advisory Board. All delegates will receive a year’s subscription to the journal and a copy of the first issue in their welcome pack.

Patterns of Association Between Alcohol Consumption and Internalizing and Externalizing Problems in Young Adults
J. Stud. Alcohol Drugs 69: 49-57, 2008

This study examined levels of internalizing and externalizing problems over the full spectrum of alcohol consumption in young adults and identified whether social factors account for the associations of alcohol consumption with internalizing and externalizing problems.

U-shaped associations were found between alcohol consumption and various internalizing problems. Low social support accounted for higher rates of internalizing problems in nondrinkers and negative social exchange accounted for higher rates of internalizing problems in excessive drinkers. Also, excessive drinking was associated with various externalizing problems. A J-shaped association was found between alcohol consumption and aggressive behavior, with higher rates for occasional and excessive drinkers compared with low-level drinkers. Negative social exchange partly accounted for associations between alcohol consumption and externalizing problems.

Nondrinkers and excessive drinkers differ from low-level drinkers in risk factors for poor mental health, and these factors may contribute to their elevated rates of mental health problems.

Interventions that address the experience of negative social exchange may produce both mental health benefits and a reduction of excessive drinking.

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Thursday, December 20, 2007

A Brief Intervention for At-Risk Drinking in an Employee Assistance Program
J. Stud. Alcohol Drugs 69: 14-20, 2008

The current pilot study examined the preliminary efficacy of a brief intervention (BI) for at-risk drinking in an employee assistance program.

Clients (N = 107) entering the employee assistance program (EAP) for mental health services were screened and met criteria for at-risk drinking. EAP therapists were randomly assigned to deliver either the BI plus EAP services as usual (SAU) or SAU only. Participants in the final analyses consisted of 44 BI + SAU (30 women, 14 men) and 30 SAU (21 women, 9 men) EAP clients who completed a 3-month follow-up.

Results suggested that participants in the BI + SAU group had significant reductions in peak blood alcohol concentration, peak quantity, and alcohol-related consequences compared with the SAU group. Men in the BI SAU group had greater reductions in alcohol-related problems compared with men in the SAU group. Groups did not differ by number of total EAP sessions attended or rates of presenting problem resolution.

Results provide preliminary evidence to support the integration of alcohol screening and BI as a low-cost method of intervening with clients with at-risk drinking in the context of co-occurring presenting problems

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Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (The COMBINE Study): Examination of Posttreatment Drinking Outcomes
J. Stud. Alcohol Drugs 69: 5-13, 2008

The aim of this study was to examine the efficacy of pharmacological and behavioral interventions across 1 year posttreatment in the COMBINE (Combining Medications and Behavioral Interventions) Study.

Alcohol-dependent individuals (N 1,383; 428 women) recruited at 11 outpatient academic alcoholism-treatment clinics across the United States participated in a randomized, double-blind, placebo-controlled trial. They received 16 weeks of naltrexone (Revia) or acamprosate (Campral) or both medications and/or placebos in combination with medical management (MM), with or without combined behavioral intervention (CBI); one group received CBI without pills or MM. Drinking behavior and clinical status were assessed at the end of treatment (Week 16) and at Weeks 26, 52, and 68

Prior treatment with active naltrexone, without active acamprosate or CBI or with active acamprosate plus CBI, and CBI with double placebo resulted in a significantly higher percentage of days abstinent than double placebos with no CBI (p < .05). Having received CBI was associated with positive clinical response posttreatment, compared with not having received CBI. Prior treatment with naltrexone increased the time to the first heavy-drinking day posttreatment (p = .03). No differences were found between patients who had received CBI without MM or pills and those having received MM and double placebo with or without CBI. No significant main effects for acamprosate were found on any of the outcome measures.

Previous treatment with MM and either CBI or naltrexone, or both, but not acamprosate, was associated with sustained efficacy beyond discontinuation. Reasons for the maintained treatment gains with naltrexone and/or CBI and potential methods to extend them are discussed.

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News Release - Top doctors call for tougher measures to reduce alcohol-related harm
Editorial: Reducing the harms of alcohol in the UK

Doctors writing in this week’s Christmas issue of the BMJ call on the government to introduce tougher measures to reduce alcohol related harm.

Ian Gilmore, President of the Royal College of Physicians and Nick Sheron, a liver specialist at Southampton University Hospital argue that measures favoured by the government and the alcohol industry – namely education and public information – have not generally been shown to change drinking behaviour or to reduce harm.

Instead proven measures, such as increasing the price of alcohol, banning alcohol advertising, and reducing the availability of alcohol, should be considered.
. . . . .

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Editorials - Reducing the harms of alcohol in the UK
BMJ 2007;335:1271-1272 (22 December)

Successful policies have worked elsewhere, so delays in implementing them are costing lives

Alcohol causes major health problems—the Cabinet Office reported up to 150 000 hospital admissions and 15 000-22 000 deaths overall in 2003.1 Between 1991 and 2005, deaths directly attributed to alcohol almost doubled.2 More people are dying from alcohol related causes than from breast cancer, cervical cancer, and infection with methicillin resistant Staphylococcus aureus combined. Furthermore, the recent report from the World Cancer Research fund confirmed that even drinking alcohol within so called "safe limits" increases the risk of cancer of the breast and upper gastrointestinal tract.3

The cultural and sociological factors that determine our patterns of drinking may date back thousands of years.4 As such, the Licensing Act 2005 was always unlikely to transform the culture of feast drinking to that of a Mediterranean society. Similarly, other options to reduce harm favoured by government and the alcohol industry—education and public information—don’t seem to change drinking behaviour or to reduce . . .

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Alcohol: Price, Policy and Public Health,

This report presents the findings of an expert workshop convened by SHAAP that focused specifically on pricing policy measures open to government. The workshop considered this particular aspect of alcohol policy in view of the significant international evidence base, which confirms that price and taxation strategies are one of the most effective and costeffective policy options available to governments to reduce alcohol-related harm.

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News Release - Older People 'Ignore Their Drinking Limits'

Older people are worse than younger people at sticking to their drinking limits, according to a new survey.

The Know Your Limits survey by YouGov found that 44% of 30 to 50-year-olds admitted to drinking too much at times, compared to 40% of 18 - 29-year-olds.

One in three in the older age group said that drinking too much had ruined at least one night out for them in the past year, while 49% admitted that excessive drinking had left with a hangover which left them unable to function properly the next day.

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Washington Weekly Roundup
December 20, 2007


Congress Approves FY 2008 Omnibus Spending Bill, Including Labor HHS Funding, Before Adjourning; President Expected to Sign Measure into Law

This week, both the U.S. House and Senate approved a FY 2008 funding package that includes spending for programs in the Departments of Labor, Health and Human Services (HHS), Education, and a number of other federal agencies. The House approved the $555 billion omnibus funding package on December 19th by a 272 to 142 vote. On December 18th, the Senate approved the funding package by a 76 to 17 vote. The President has indicated that he will sign the measure into law. Although the 2008 fiscal year began on October 1st, most federal agencies and programs have continued to receive funding at FY 2007 levels under a number of short-term Continuing Resolutions (CR) approved by Congress.

Congress crafted this funding package following the President’s veto of an earlier FY 2008 Labor HHS funding bill that exceeded his budget targets. To bring funding for programs in the Departments of Labor, HHS and Education within the President’s spending cap, Congress used a 1.747 percent across-the-board cut to reduce funding amounts for programs in these agencies. Despite these reductions, most drug and alcohol treatment, prevention and research programs would receive small increases or level funding under the omnibus spending bill. However, under the spending bill, the Safe and Drug Free Schools and Communities State Grants program would receive a significant funding cut.

Under the spending measure, drug and alcohol education, prevention, treatment and research programming would receive the following amounts:

  • The Substance Abuse Prevention and Treatment (SAPT) Block Grant would receive $1.7587 billion, funding roughly level to FY 2007 and the President’s budget request
  • The Center for Substance Abuse Treatment (CSAT) would receive $399.8 million, $895,000 over FY 2007 and $52 million over the President’s budget request
  • The Center for Substance Abuse Prevention (CSAP) would receive $194.12 million, a $1.2 million increase over 2007 and $37.6 million over the President’s request
  • The Safe and Drug-Free Schools and Communities (SDFSC) State Grants program would receive $294.76 million, a cut of $51.7 million from last year’s funding but $194.7 million over the President’s FY 2008 budget request
  • The National Institute on Drug Abuse (NIDA) would receive $1.001 billion, $2 million over FY 2007 and $1 million more than the President’s budget request
  • The National Institute on Alcohol Abuse and Alcoholism (NIAAA) would receive $436.26 million, a $674,000 million increase over last year’s funding and approximately $700,000 less than the President’s budget request

Both the House and the Senate adjourned on December 19th, ending the first session of the 110th Congress. The second session of the 110th Congress is set to begin in mid January when members return to Washington from their home districts. More information about the omnibus spending bill can be found at:


Faces & Voieces in Recovery
eNewsletter December 20, 2007

Ending insurance discrimination

Congress did not act on the Paul Wellstone Mental Health and Addiction Equity Act before it adjourned. Because of your advocacy and the advocacy of allied organizations, the issue will be on the front burner when members return to Washington at the end of January. Learn more…

Congress moves to approve FY 2008 funding

The House and Senate have approved a $555 billion omnibus spending bill that will fund the government for the rest of the fiscal year. The bill combined 11 unfinished funding measures Learn more…

Profiles of Recovery Advocacy in Action
The eighth in our series of interviews with recovery advocates from across the country by Bill White and Pat Taylor features Don Coyhis, President and co-founder of White Bison, Inc. Learn more…

Recovery Advocacy Teleconferences in 2008
January 30: Recovery Voices Count; February 27: Recovery Community Centers Part 1; March 26: Recovery Community Centers Part 2. All at 3:00 pm Eastern. Mark your calendar, details to follow!

2008 Faces and Voices' organizing network
In February Faces & Voices' organizing network will get underway to work with recovery community organizations on Rally for Recovery! and Recovery Voices Count. If you’d like to participate and to find out more, contact us.

Recovery Advocacy and You Tube

Parent-to-Parent, a South Jersey based organization which assists parents with addicted children statewide, and NCADD-New Jersey continued their push for mental health and addiction parity Learn more…


Employment Opportunity: Connecticut Community for Addiction Recovery (CCAR) is looking for a Telephone Recovery Support Coordinator at its Windham Recovery Community Center. Learn more…

Employment Opportunity: Hazelden is looking for a Director of Public Advocacy to direct and support Hazelden's activities to expand public education, influence public policy Learn more…

Important sentencing reform successes have been secured over the last few weeks. Supreme Court rulings on two sentencing cases gives federal court judges discretion to reduce Learn more…

Unlocking America: Why and How to Reduce America’s Prison Population by the JFA Institute focuses on ways to reduce the prison population in the United States and makes several recommendations for changing current sentencing laws and correctional policies. Additionally, the report identifies the limits of current prison-based treatment and includes a discussion about decriminalizing non-violent drug offenses.

Kellogg Health Scholars Program is recruiting applicants for its 2008-2010 program that will begin in fall 2008. The deadline for submitting online applications is Tuesday, January 8, 2008. Learn more...

Our very best wishes in the coming year!


34th Annual Alcohol Epidemiology Symposium of the Kettil Bruun Society (KBS 2008) 2-6 June

Next year, the KBS conference will be held in Victoria, British Columbia,Canada at the Harbour Towers Hotel and suites ( from June 2 to June 6, 2007. The conference will be coordinated by Scott Macdonald ( For more information see

Wednesday, December 19, 2007

Interactions of wine drinking with omega-3 fatty acids in patients with coronary heart disease: A fish-like effect of moderate wine drinking
American Heart Journal Volume 155, Issue 1, Pages 175-181 (January 2008)

Moderate alcohol drinking and marine omega-3 fatty acids (ω3) have both been associated with low mortality from coronary heart disease (CHD). However, there is little data evaluating the interactions of wine ethanol drinking with ω3 in CHD patients.

The relationships between wine drinking and marine ω3 were evaluated in a cross-sectional study in patients with CHD participating in a randomized trial testing the effect of a high α-linolenic acid (ALA, the main plant ω3) diet. Daily ethanol intake was calculated as energy and expressed as a percentage of total energy. Plant and marine ω3 in the diet were carefully evaluated in each patient in both groups.

Patients were classified according to their habitual consumption of ethanol. Patients in the “high ALA group” and controls (“low ALA group”) were analyzed separately. Within each group, there was a progressive increase in marine ω3 levels with increased alcohol intake, with a level of eicosapentanoic acid (EPA) that increased by 50% (P < .005) and 37% (P < .05) in the low and high ALA groups, respectively. After controlling for potential confounders (including dietary EPA) in a multivariate linear model, the association between wine ethanol and EPA remained significant in the low (P < .001) and high (P < .05) ALA groups.

In these patients with CHD, moderate wine drinking was associated with higher marine ω3 concentrations than no alcohol use. Although the data have to be confirmed in large groups, this effect of wine comparable to that of fish may partly explain the protective effects of wine drinking against CHD.

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Alcohol platform announces first commitments
Published: Wednesday 19 December 2007

The alcohol industry, doctors, publishers and NGOs alike have pledged a series of actions to promote responsible drinking, curb under-age alcohol consumption and promote behavioural change among adolescents

A CommunicationPdf external on an EU alcohol strategy to reduce the health and social harm related to alcohol consumption was adopted by the Commission in October 2006. The document set out five priorities in the fight against alcohol abuse:

  • Protection of young people and children;
  • reduction of alcohol-related road accidents;
  • reduction of the negative impact on the economy;
  • raising awareness of health impacts of alcohol abuse; and;
  • collection and dissemination of reliable data.

The Communication also announced the creation of an EU 'Alcohol and Health Forum' (AHF), which was officially launched in June 2007. It brings together some 40 business and non-governmental organisations to discuss and commit to action to protect European citizens from harmful abuse of alcohol - just as the EU 'Obesity' Platform for Diet, Physical Activity and Health has pledged commitments to promote a healthy diet and more physical activity.

The charterPdf external establishing AHF announces that stakeholders will put special emphasis on actions to protect children and young people, promote responsibility and prevent irresponsible commercial communication and sales.
. . . . . . .

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Human γ-aminobutyric acid A receptor α2 gene moderates the acute effects of alcohol and brain mRNA expression
Genes, Brain and Behavior (OnlineEarly Articles) 19 December 2007

γ-aminobutyric acid A (GABAA) receptors moderate several of the behavioral effects of alcohol. In fact, recent studies have shown an association between the gene for the α2-subunit of the GABAA receptor (GABRA2) and alcoholism.

In the present study, we examined the functional relevance of the GABRA2 gene in alcohol dependence by assessing brain GABRA2 mRNA and GABAA α2-subunit protein levels in post-mortem prefrontal cortical tissue collected from control and alcohol-dependent individuals.

In addition, using an endophenotype approach, we tested whether the GABRA2 gene moderates sensitivity to the acute effects of alcohol in two independent samples from distinct human alcohol challenge studies.

Results indicated that GABRA2 mRNA levels significantly differed by GABRA2 genotype. GABRA2 single nucleotide polymorphisms (rs573400, rs279871 and rs279858) were significantly associated with sensitivity to the acute effects of alcohol.

Specifically, there was a significant main effect of GABRA2 × breath alcohol concentration on several measures of subjective responses to alcohol, including the hedonic value of alcohol.

Importantly, reanalysis of a previous intravenous alcohol administration study confirmed the results of the oral alcohol challenge study.

In summary, these results extend previous findings and provide new insights into the putative biobehavioral mechanisms that may moderate the association between the GABRA2 gene, sensitivity to the acute effects of alcohol and ultimately alcohol dependence.

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Youth Exposure to Alcohol Advertising on Television and in National Magazines, 2001 to 2006

Press reports1 and data from the Center on Alcohol Marketing and Youth (CAMY) indicate that alcohol companies are increasingly shifting their advertising from magazines to television, the Internet and other "new media." Looking at magazines and television from 2001 to 2006 reveals that youth2 exposure to alcohol advertising has indeed fallen in magazines, but this decline has been accompanied by an increase in youth exposure to alcohol advertising on television.

The Center on Alcohol Marketing and Youth asked Virtual Media Resources to analyze 19,466 alcohol advertisements placed in national magazines and 1,693,594 alcohol advertisements placed on cable and broadcast network television and local broadcast television from 2001 to 2006.

Key Findings

  • From 2001 to 2006, the number of alcohol advertisements in national magazines fell by 22% (from 3,616 to 2,831), while alcohol advertising spending in magazines peaked at $361 million in 2004 but fell to $331 million by 2006.

  • Youth, young adult and adult exposure to alcohol advertising in national magazines fell by 50%, 33% and 28% respectively from 2001 to 2006.

  • From 2001 to 2006, alcohol advertising spending on television increased by 27% (from $779 million to $992 million), while the number of advertisements on television grew by 33% (from 225,619 to 299,475).

  • Youth, young adult and adult exposure to alcohol advertising on television increased by 30%, 25% and 29% respectively from 2001 to 2006.

  • Compliance with the alcohol industry's voluntary 30% maximum for underage audiences of its advertising, a standard adopted in late 2003, has been good:
    – In 2006, 3% of alcohol advertisements in national magazines (90 of 2,831 advertisements) were placed in magazines with youth audiences larger than 30%.
    – In 2006, 6% of alcohol advertisements on television (18,220 of 299,475 advertisements) were placed on programming with underage audiences larger than 30%.

  • The 30% standard has produced slight progress in reducing youth exposure or overexposure to alcohol advertising:
    – Overall, declines in youth exposure to alcohol advertising in magazines have been nearly offset by the increase in exposure coming from television advertising.
    – On television, the percentage of youth exposure coming from alcohol advertising placed where youth are more likely to see it per capita than adults was virtually the same in 2006 as in 2001.3
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Tuesday, December 18, 2007

Addiction as a complex social process: An action theoretical perspective
Addiction Research & Theory 17 December 2007

This article introduces an action theoretical perspective of addiction. The view that addiction resides solely within the individual continues to foster significant limitations across addiction theorizing, research, and treatment.

Exclusive focus on an individual neurobiological level of analysis precludes important additional layers of understanding, for example, the roles of individual and joint human actions, the socially constituting processes of addiction, and the role of gender.

Our perspective is that a neurobiological view on addiction is insufficient without consideration of goals, intentionality, relationships, and meaning. Using a composite case scenario, we offer an action theoretical framework for understanding individual and joint addiction processes over time and within the context of other life processes. This integrative framework considers manifest behaviors, internal and communicative processes, and the social meaning of addiction.

This article offers a practical application of the theory and draws broad implications for the conceptualization and subsequent language of addiction.

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Stimulant alcohol effects prime within session drinking behavior
Psychopharmacology Online First 15 December 2007

Individual differences in subjective alcohol effects have been shown to differ by risk status (e.g., family history of alcoholism) and to predict future risk for alcohol-related problems.

Presumably, individual differences in both stimulant and sedative responses affect the rewarding value of drinking which, in turn, impacts future drinking behavior. Although plausible, this theoretical model is largely untested.

The current study attempted to provide experimental evidence for the impact of subjective alcohol responses on within session drinking behavior.

Analyses indicated that an initial dose of alcohol increased experiences of both stimulation and sedation although stimulant effects were evaluated much more positively. In addition, stimulant effects after a priming dose predicted further consumption, whereas sedative effects did not.

At least among moderate to heavy drinking college students, stimulant alcohol effects are more reinforcing and predict within session drinking behavior under social stress. Increased attention should be given to stimulant alcohol effects as a risk factor for excessive consumption in this population.

Incorporating information about stimulant alcohol effects in prevention and intervention programs may also be important if additional research supports the current results.

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Acute alcohol tolerance is intrinsic to the BKCa protein, but is modulated by the lipid environment
Paper in press, published online ahead of press December 15, 2007

Ethanol tolerance, in which exposure leads to reduced sensitivity, is an important component of alcohol abuse and addiction. The molecular mechanisms underlying this process remain poorly understood.

The BKCa channel plays a central role in the behavioral response to ethanol in C. elegans (1), and Drosophila (2). In neurons, ethanol tolerance in BKCa channels has two components: a reduced number of membrane channels, and decreased potentiation of the remaining channels (3).

Here, heterologous expression, coupled with planar bilayer techniques examines two additional aspects of tolerance in human BKCa channels: 1) Is acute tolerance observed in a single channel protein complex within a lipid environment reduced to only two lipids? 2) Does lipid bilayer composition affect the appearance of acute tolerance?

We found that tolerance was observable in BKCa channels in membrane patches pulled from HEK cells, and when they are placed into reconstituted POPE/POPS membranes. Further, altering bilayer thickness by incorporating the channel into lipid mixtures of DOPE with phosphatidylcholines (PCs) of increasing chain length, or with sphingomyelin (SPM), strongly affected the sensitivity of the channel, as well as the time course of the acute response. Ethanol sensitivity changed from a strong potentiation in thin bilayers, to inhibition in thick SPM/DOPE bilayers.

Thus, tolerance can be an intrinsic property of the channel protein/lipid complex, and bilayer thickness plays an important role in shaping the pattern of response to ethanol. As a consequence of these findings the protein/lipid complex should be treated as a unit when studying ethanol action.

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